The Geriatric Workforce Enhancement Program (GWEP) advances rural northern New England's regional capacity to address the healthcare needs of older adults and informs national geriatric workforce improvement.
To learn more about the GWEP research proposal, please see the Northern New England Geriatric Workforce Enhancement Program section under the Family Medicine Sponsored Research page.
The following GWEP projects are currently in progress:
- APRN Post Graduate Training in Long-Term Care 2025: This is a training program for recently graduated associate providers who are working in nursing facilities. It consists of weekly sessions that include didactic content, a case study, and peer and faculty mentoring, led by a GWEP faculty member who is the medical director at a rural nursing facility.
- Falls prevention education: The Geriatric Center of Excellence (GCOE) Falls Prevention team works within the Dartmouth Health system and partners throughout New England to screen individuals for fall risk and help them engage in effective falls prevention intervention.
- Geriatric Interprofessional Team Transformation in Primary Care (GITT-PC): A model developed by NNEGEC that focuses on workforce culture change to empower primary care teams to achieve best practice in geriatrics in primary care.
- Geriatric Interprofessional Team Transformation in Skilled Nursing Facilities (GITT-SNF): GITT-SNF is a new, innovative method to educate and train students and staff in underserved, rural nursing homes with the goal of attracting and retaining hands-on healthcare workers who have interest or expertise in geriatrics.
- Geriatric Mental Health in Primary Care ECHO: This ECHO provides information on current topics in geriatric mental health care, including best practices for assessment and treatment
- Positive Approaches to Dementia Care ECHO: Join us and members of Teepa Snow’s Positive Approach to Care team to learn about the impact dementia has on function, emotions, sensory processing, and overall quality of life. Equip yourself with a refreshed approach, practical skills, and techniques that will enhance the quality of care you provide and your interactions with persons living with dementia (PLwD).
- SNF POLST Project: The SNF (Skilled Nursing Facilities) POLST (Provider Orders for Life-Sustaining Treatment) Project uses a model that systematically and significantly reduces unwarranted and unwanted use of the Emergency Department by residents of Skilled Nursing Facilities.
- Student POLST Project: This project aims to build important skills by focusing on the POLST form, a national document to clarify and codify a vulnerable patient's wishes for treatment in the event of an acute illness or decline.
APRN Post Graduate Training in Long-Term Care
The APRN (Advanced Practice Registered Nurse) Post Graduate Training in Long-Term Care a training program for recently graduated associate providers who are working in nursing facilities. It consists of weekly sessions that include didactic content, a case study, and peer and faculty mentoring, led by a GWEP faculty member who is the medical director at a rural nursing facility. The program consists of one cohort who participates over the course of two years. The program has included sessions on a range of primary care topics, for example pain management, weight loss, falls risk, mental status changes, renal disease, and dyspnea.
Falls prevention education
The Geriatric Center of Excellence (GCOE) Falls Prevention team works within the Dartmouth Health system as well as with partners throughout New England to screen individuals for fall risk and help them engage in effective falls prevention intervention.
The Falls Prevention team works closely with teams in the following Dartmouth Health departments and programs:
- Aging Resource Center
- Geriatric Emergency Department
- Injury Prevention Center
- Rehabilitation Medicine
- Trauma Program
The GCOE team provides leadership and collaborates with the New Hampshire Falls Risk Reduction Task Force, a statewide falls prevention coalition.
The Falls Prevention team delivers training and implementation support to community-based organizations and primary care providers on falls risk screening, referral pathways, and capacity-building for sustainable, effective falls prevention programs. This training aligns with efforts to integrate primary care with community-based organizations and to promote Age-Friendly Health Systems.
Geriatric Interprofessional Team Transformation in Primary Care (GITT-PC)
Geriatric Interprofessional Team Transformation in Primary Care (GITT-PC), a model developed by the NNEGEC, moves away from traditional training methodologies by focusing on workforce culture change to empower primary care teams to achieve best practice in geriatrics in primary care. This goal is accomplished by training healthcare professionals from multiple disciplines on:
- Team skills and optimal team function
- Quality improvement (QI) tools and methods
- Optimal implementation of Medicare-reimbursable services and visits, as well as the associated billing codes
As we work toward value-based healthcare and improving the coordination of care for older adults, team effectiveness is a critical component to achieving the desired outcomes for older adults.
This program uses a person-centered approach to focus on how patients can help transform the work of all primary care team members, including medical assistants, nurses, advanced practice clinicians, physicians, office managers, and support staff. While we have implemented in a multitude of primary care settings, our current grant cycle is focusing on Federally Qualified Health Centers.
We focus on best practices for Medicare-reimbursable visits such as the Annual Wellness Visit, Chronic Care Management, Transitional Care Management, and Advance Care Planning. Reimbursable visits allow participating practices to sustain their investment in implementing this model through effective billing and reimbursement.
Geriatric Interprofessional Team Transformation in Skilled Nursing Facilities (GITT-SNF)
Geriatrics Interprofessional Team Transformation in Skilled Nursing Facilities (GITT-SNF) places emphasis on caring for persons with dementia in nursing homes and addressing dementia-related behaviors. GITT-SNF is a new, innovative method to educate and train students and staff in underserved, rural nursing homes with the goal of attracting and retaining hands-on healthcare workers who have interest or expertise in geriatrics. The main activities include monthly interprofessional webinars on dementia-related behaviors, workforce development through specialized academic programming, clinical rotations in geriatric care settings, and enhanced hands-on experiential geriatrics curriculum and coaching. Drawing inspiration from the Teaching Nursing Home model and the Age Friendly Health Systems movement, GITT-SNF aims to attract clinical workforce to the field of geriatrics and equip learners with geriatric competencies through experiential learning in a long-term care setting.
Geriatric Mental Health in Primary Care ECHO
There is increasing need for mental health care across all populations, including geriatric patients. Workforce challenges have led to a shortage of mental health specialty care and many people deferred care during the COVID pandemic. In addition, there has been a surge in loneliness among the aging population, often co-occurring with behavioral health conditions such as depression and anxiety disorders. Primary Care health teams are the first line of care for many patients in need of mental health care and is the preferred setting for many patients. Treating mental health issues in older adult patients can be more complex due to physical and mental health comorbidities. Older adults may also experience losses and changes that impact their mental health. This ECHO will provide information on current topics in geriatric mental health care, including best practices for assessment and treatment
Target audience
Primary care providers and teams; ambulatory care nurses; ambulatory care MAs, LNAs, and other support staff; care coordinators, and home care team members
Contact information
For more information, contact Megan Colgan at megan.m.colgan@hitchcock.org.
Register for the Geriatric Mental Health in Primary Care ECHO.
Positive Approaches to Dementia Care ECHO
Join us and members of Teepa Snow’s Positive Approach to Care team to learn about the impact dementia has on function, emotions, sensory processing, and overall quality of life. Equip yourself with a refreshed approach, practical skills, and techniques that will enhance the quality of care you provide and your interactions with persons living with dementia (PLwD).
Target audience
Nursing students, skilled nursing facility direct care workers, uncompensated caregivers who support PLwD, and. health professionals who provide care to PLwD
Learning objectives:
At the conclusion of this learning activity, participants will be able to:
- Describe at least one of the sensory changes that can occur with dementia
- Discuss at least one example of brain function that may be retained in persons living with dementia (PLwD)
- Identify a technique or tool which may be useful when interacting with a PLwD
Contact information
For more information, contact Megan Colgan at megan.m.colgan@hitchcock.org.
Register for the Positive Approaches to Dementia Care ECHO.
SNF POLST Project
The current SNF (Skilled Nursing Facilities) POLST (Provider Orders for Life-Sustaining Treatment) Project has been adapted from a previous program, Reducing Avoidable Facility Transfers or RAFT. RAFT is a model of healthcare delivery developed at Dartmouth Hitchcock Medical Center in 2016-2018, which systematically and significantly reduces unwarranted and unwanted use of the Emergency Department by residents of Skilled Nursing Facilities. Below are the core elements from RAFT that will be used in our current model.
Core Elements of RAFT include:
- "SNFists" - Small team of geriatric providers (MDs, NPs, PAs) who manage daytime and after hours care of facility patients.
- Systematic discussions with patients/families about goals of care documented using the POLST form.
- Increased provider engagement with patients, staff, families and ED staff during an acute decline with emphasis on matching care delivery to care goals.
This training emphasizes the systematic elicitation of care goals using POLST as a means to improve care, ensure alignment with goals and reduce costs. Ultimately, through routine, systematic conversations with trained facility staff, each patient proactively identifies the responses to an acute illness or injury that most closely matches his/her goals and values.
Student POLST Project
This project aims to build important skills by focusing on the POLST form, a national document to clarify and codify a vulnerable patient's wishes for treatment in the event of an acute illness or decline. On the form, 4 specific options ranging from unlimited curative interventions to comfort care are listed. Patients and families select one of the options that best corresponds with their values and wishes.
The course involves two parts. The first is didactic and experiential training focusing on frailty, residential care, dementia and advance directives. The second is student participation in three mock conversations with the goal of completing the POLST form followed by formal feedback/critique.
The goal of these conversations for the student is threefold:
- To listen attentively and compassionately with attention on values and priorities.
- To clearly and effectively explain the POLST and the 4 options under consideration ranging from aggressive unlimited interventions to exclusively comfort focused care.
- To assist and guide the actor in the selection of one of the options in the context of values identified.
We find that this model and the use of the POLST form helps "goals of care," something many clinicians find vague and intimidating, appear more approachable and concrete and thereby provides a more comfortable and effective context in which to improve the skills needed for challenging conversations of all kinds.